Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | I-07166 | NM |
NPI | 1003133810 |
---|---|
Provider Name | Patrick Charles Kowalski |
First Address | Albuquerque, NM 87105-4610 |
Second Address | Albuquerque, NM 87105-4610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2010 |
Last Update Date | 03/05/2010 |